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A pregnant, homeless woman goes into labor on the street in Chinatown.
Emergency Medical Services Director Jim Ireland flips on the sirens of the Crisis Outreach Response and Engagement ambulance.
“Where’s the OB kit?” he asks two other CORE emergency medical technicians in the front seat of the rig one recent morning. Ireland explains that they may have to deliver the child where the woman is sitting: on the corner of North Pauahi and Hotel streets.
When CORE arrives an EMS ambulance is already there, and the woman is
resisting first responders,
asking them to let her finish her lunch. Eventually, she is transported to Kapiolani Medical Center for Women &Children, and a CORE member goes along.
This was not a typical call for the city’s new CORE program, which is meant to respond to nonemergency, nonviolent, homeless-related 911 calls. However, Ireland said the CORE ambulance is versatile enough that it can respond to emergency calls such as a cardiac arrest or, in this case, a baby delivery.
The CORE team, composed of two EMTs, a program manager, two caseworkers, two community health workers and, for now, Ireland, typically spends its time talking to homeless individuals, treating their wounds and giving them the resources that could lead to permanent housing.
The long-awaited initiative began in October and diverts low-level 911 calls involving the homeless. It is a program that is evolving.
The original concept was to divert nonviolent, homeless-related 911 calls away from the Honolulu Police Department, sending social workers in their place. CORE can respond with HPD but not necessarily go in its place. If dispatchers would normally send police to respond to the call, for the safety of the CORE workers, HPD will still respond.
“If it’s a potentially dangerous situation, we don’t mind being out front. We don’t mind doing the deescalation,” Ireland said. “But we need them there if things escalate.”
Funding for CORE for the next four years will come from an allocated $3.5 million of federal funds received from the American Rescue Plan Act, meant to help the city address the financial distress caused by COVID-19.
CORE is modeled after several similar programs across the country, including CAHOOTS in Eugene, Ore., and STAR in Denver. Ireland and Office of Housing and Homelessness Director Anton Krucky decided it would be best to operate it through EMS so that 911 calls could be directly diverted.
Dispatchers determine whether the situation is critical, serious or minor, and if the minor call is homelessness-related, a CORE ambulance is sent.
One of the key differences between CORE and a traditional ambulance is time, Ireland said.
“If it’s paramedics and EMTs, they’re going to save your life. But once they get them to the ER, that’s the end of the relationship … they’ve got to go to the next 911 call,” said Ireland. “Whereas, CORE this morning for three hours was there with one person. And we ended up taking him to his doctor’s office at the VA.”
Ireland explained that if they had taken the man to the ER, once he was released he would have immediately called 911 again. In one instance, EMS served that man three times in one day.
“I feel like today was like groundbreaking,” said Jolene Chun, one of the CORE EMTs.
“Ordinarily, we’re only going to ERs. He didn’t need that, so being able to have the patience to take him where he needed to be — that’s the thing.”
Chun was with EMS on traditional ambulances for the past five years, before joining CORE.
That’s CORE’s goal, to come in contact with the homeless individuals who generate the most 911 calls. Ireland estimated that by convincing even just one to enter a shelter or seek permanent housing, it could save 100 911 calls a year.
Of the 10 people who call EMS most, five of them generate 80 calls a month.
In addition to responding to 911 calls, the CORE team will patrol on foot.
For now it is focusing on the Chinatown area, but in January will expand into Waikiki.
On average during an eight-hour day, CORE responds to about three or four 911 calls, engaging with about 15 people on foot.
While walking down Hotel Street last week, Chun and the other EMT, Alyssa Bustamante, approach a man named Daniel Kaopuiki in an office chair on the sidewalk.
They introduce themselves and notice his foot is a little swollen. They ask whether he has any history of heart problems and whether he’s gotten a COVID-19 vaccine.
Then they ask whether he would be interested in going to a shelter. Kaopuiki says no because he does not want to abide by any curfews.
Ireland thinks that if the CORE team keeps talking to Kaopuiki, they can possibly find him a place where rules about coming and going are not as strict.
On foot patrol, the CORE workers are identifiable by the red T-shirt they wear with either jeans or black cargo pants.
Some shop owners say they hadn’t yet noticed the patrols. But others like Yihua Lin, owner of Chun Fa Collection on Hotel Street, said she has.
“Yeah, I saw them yesterday and today,” said Lin.
Starting today, CORE will have a dedicated phone number, 808-768-2673, that people can call instead of 911 for homelessness-related nonemergencies.
Katrina Long, who owns Fred’s Sundries, said she would still probably use 911 because the only time she calls is when she thinks someone is trying to steal from the store.
Lin said he would use the number because he often calls 911 to report people sleeping or defecating in front of his store.
“Is there a need for more social services, as opposed to less of a need for medical intervention, as in triage, that kind of stuff? Sure,” said Chinatown/Downtown Neighborhood Board member Robert Armstrong.
“So if the city is moving in that direction, and has a sustained plan for what this looks like in the long term. I’m all for it, but I don’t know enough about the details.”
Because the program is so new, it is still evolving.
Ireland said he does not want to duplicate the work of nonprofit groups such as the Hawai‘i Health &Harm Reduction Center, Partners and Care and Institute of Human Services, so he is meeting with them to see where CORE can fill their gaps in service.
CORE Program Manager Ryechelle Rin said she already is working with Partners in Care, and has access to the data system that allows different care providers to input and track people they’ve come in contact with.
In the weeks since operations began, one takeaway for the CORE team is that the ambulance should be equipped with a small cage to allow people to bring their pets with them.
During storms earlier this month, Ireland and the team helped a paralyzed, homeless man who was unable to escape flooding at Ala Moana Beach Park. The man was taken to a hospital, but he did not want to leave behind his small dog, Smiley.
Ireland said he is keeping the dog at his house until the man is released.
“I’m not going to be able to do that on a regular basis,” he said. “We just have to think outside the box in this CORE group and do things differently, because I think that’s delivered results.”
A key feature of the CORE initiative is that it allows team members to see patients after they are released from the hospital, providing transportation and following up with additional service options.
CORE has also been utilizing the Punawai Rest Stop, a hygiene and medical clinic, bringing patients there instead of the emergency room.
The city is expected to hire eight more people for CORE in December and another 15 in early 2022, including a social worker, nurse practitioners and potentially a psychiatrist.
In addition to the two ambulances assigned to CORE, Ireland expects to get six more.
CORE EMT Bustamante, who has known people who struggled with addiction and homelessness, said she’s proud of the work the current team has been able to do.
“I’m very passionate about the medical portion, but the the fact that we’re dealing with homeless and helping these people get off the street, and helping them with addiction or helping them with housing, that’s also very passionate for me because of my background,” she said.
“They’re getting to know us, too. And I love how they see us different than everyone else. That’s what we want.”
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